Provider Demographics
NPI:1164503421
Name:OGLALA SIOUX TRIBE
Entity Type:Organization
Organization Name:OGLALA SIOUX TRIBE
Other - Org Name:NATIVE WOMENS HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TWO BULLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-342-7400
Mailing Address - Street 1:3200 CANYON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8114
Mailing Address - Country:US
Mailing Address - Phone:605-342-7400
Mailing Address - Fax:605-342-8239
Practice Address - Street 1:3200 CANYON LAKE DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8114
Practice Address - Country:US
Practice Address - Phone:605-342-7400
Practice Address - Fax:605-342-8239
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OGLALA SIOUX TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-17
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1164503421OtherWELLMARK